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Future Cooperation with and among ASEAN countries for the Aging Population

The 11th ASEAN & Japan High Level Officials Meeting on Caring Societies

Panel Discussion 6

Yutaka Horie, MBA, PhDDeputy Assistant Minister for International Affairs,

Minister's Secretariat, Ministry of Health, Labour and Welfare, Government of Japan

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Lesson Learned

&What to do

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Lesson Learned① UHC as a basis for “Active Aging”, Medical

and Welfare services, Health Promotion, and Diseases Prevention.

② Local Communities that Support the Elderly③ Social Involvement and Contribution by the

Elderly: Social Participation④ The roles of the Government in “Active

Aging”

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What to do next ?

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Active Aging

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5W1H• Why• Who• When• Where• What• How

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Why

Active Aging is Challenge?

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●Declining Working Generation

●Urbanization with declining Community

strength

●Dominating NCD over infections disease

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Who

Aging rate1990(60+)（%）1)

Aging rate2010(60+)（%）1)

Prospect of aging

rate2025 (60+)（%）1)

Prospect of aging

rate2050(60+)（%）1)

Total fertility rate1)

Life expectancy at birth 1)

Labor-force participation ratio（60-64year-old）2)

Per capita GDP

(US$)3)

Income disparity(Richest 10% to poorest 10%)4)

Male Female Male Female

Japan 17.4 30.5 35.5 41.5 1.32 79.3 86.1 76.0 45.7 45,903 4.5

Republic of Korea 7.7 15.7 27.2 38.9 1.29 76.5 83.3 70.2 41.5 22,424 7.8

Singapore 8.4 14.0 27.1 37.8 1.25 78.5 82.7 67.5 35.4 46,241 17.7

Thailand 7.3 12.9 21.3 31.8 1.63 70.2 77.1 50.1(60-)

29.5(60-)

4,972 12.6

China 8.9 12.3 20.2 33.9 1.64 71.1 74.5 58.3 40.6 5,445 21.6

Vietnam 7.3 8.4 15.3 30.8 1.89 72.3 76.2 69.4 58.2 1,407 6.9

Indonesia 6.1 8.2 13.2 25.5 2.19 66.3 69.4 78.9 47.3 3,495 7.8

Malaysia 5.6 7.7 13.1 20.4 2.72 71.2 75.7 52.3 17.1 9,977 22.1

Myanmar 7.0 7.9 13.0 24.5 2.08 62.1 65.0 - - 880 -

Brunei Darussalam 4.4 5.7 12.1 23.1 2.11 75.3 80.0 45.5 11.2 40,301 -

Cambodia 4.5 6.2 9.5 19.0 2.80 60.2 62.6 69.5 33.0 897 12.2

Philippines 4.7 5.7 8.9 15.3 3.27 64.5 71.3 79.0(55-64)

54.8(55-64)

2,370 15.5

Lao PDR 5.7 5.9 8.4 18.9 3.02 64.8 67.3 - - 1,320 8.3

Source 1) UN: World Population Prospects: The 2010 Revision Population Database2) Statistical data of respective countries. 3) World Bank Search 2011 (Myanmar ; National Accounts Estimates of Main Aggregates, 2010, United Nations Statistics Division）4) Human Development Report 2007/2008:Published for the United Nations Development Programme (UNDP) 10

Comparison of Aging-Related Indicators (ASEAN+3)

2013.6.14厚生労働省第1回「国際的なActive Agingにおける日本の貢献に関する検討会」

Percentage of total deaths by broad age group (both sexes)Country 0-4 0-14 0-19 15-59 15-64 40+ 50+ 60+ 70+ 80+ 90+

Japan 1950-1955 19.8 23.0 24.9 31.2 38.6 63.4 56.5 45.8 29.1 9.5 0.9Japan 1960-1965 7.9 9.4 10.6 26.9 35.7 81.3 75.4 63.8 43.9 17.9 2.0Japan 0.4 0.5 0.6 10.5 16.2 97.6 95.3 89.0 76.1 51.5 18.5

Singapore 0.7 1.0 1.3 21.1 29.1 95.5 89.9 77.8 60.3 33.8 8.9Malaysia 2.5 3.6 5.0 31.5 40.5 86.2 78.1 64.9 45.2 19.5 2.7Viet Nam 7.0 8.5 9.9 29.2 34.4 80.7 73.0 62.3 50.3 29.6 9.5Thailand 2.5 3.9 5.1 35.9 42.9 83.7 73.6 60.2 44.6 22.3 4.9Brunei Darussalam 4.1 5.4 6.5 35.3 42.4 84.3 73.8 59.3 44.2 21.4 4.1Indonesia 12.1 13.8 15.1 29.1 36.7 76.1 68.6 57.0 40.1 18.0 2.2Myanmar 15.3 17.8 19.7 33.8 40.4 68.4 60.1 48.5 33.9 14.1 1.7Philippines 13.1 15.4 17.1 38.1 46.2 71.1 61.1 46.4 29.7 12.5 1.8Lao People's Democratic Republic24.8 28.4 30.9 28.5 34.4 58.5 52.2 43.1 29.9 12.4 1.5Cambodia 26.4 33.0 36.3 35.7 40.3 49.7 40.5 31.3 21.8 11.0 3.0

Republic of Korea 1.1 1.5 1.8 20.8 27.6 94.4 87.9 77.7 61.2 32.6 7.1China 4.2 4.8 5.6 22.3 29.4 88.6 83.0 73.0 56.0 27.6 5.6

Percentage of Deaths by Age Groups (ASEAN+3)

Sorted by the "shares of deaths 60+" Period: 2005-2010UN World Population Prospects: The 2012 Revision

Yutaka HORIE, MBA, PhDASEAN-Japan Seminar, The Regional Cooperation for the Aging Society11th November, 2013 11

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When

Target Countries

Rapid Aging2025 aging rate ≧20%(60+)(2010→2025)

Moderate Aging10% ≦2025 aging rate < 20% (60+)(2010→2025)

Young2025 aging rate < 10%(60+)

(2010→2025)

High Income CountryGDP per Capita: >10,000$

Japan(30.5%→35.5%)

Singapore(14.0%→27.1%)Republic of Korea（15.7%→27.2%)

Brunei Darussalam(5.7%→12.1%)

Middle Income CountryGDP per Capita: >1,000$

Thailand(12.9%→21.3%)China(12.3%→20.2%)

Malaysia(7.7%→13.1%)

Indonesia(8.2→13.2%)

Vietnam(8.4%→15.3%)

Philippines(5.7%→8.9%)Lao PDR(5.9%→8.4%)

Low Income CountryGDP per Capita: <1,000$

Myanmar(7.9%→13.0%) Cambodia(6.2%→9.5%)

Source ・UN: World Population Prospects: The 2010 Revision Population Database・ World Bank Search 2011 (Myanmar ; National Accounts Estimates of Main Aggregates, 2010,

United Nations Statistics Division）

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2013.6.14厚生労働省第1回「国際的なActive Agingにおける日本の貢献に関する検討会」

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Where

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●Urban area → Social isolation and economic

gap are more evident.

●Rural area → Scarce working generation tends

to weaker community strength.

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What

Cooperation Interface on Active Aging between Japan and ASEAN countries

Health

Participation

Security

・Empowering Community Strength・Elderly Club Activities・Volunteer Network・Income Generation・Expanding Elderly Employment

・UHC (accessible and sustainable health system)・Income Security (public pension)・Long Term Care Insurance・Human Rights

・Service Standards and Regulation・Qualified Human Resources・Health Promotion Activities for NCD prevention・Expanding Home Care Services・Government Commitments to Securing Services

Japan Japan

ASEAN Japan

Active Aging KnowledgeExperience

KnowledgeExperience

ASEAN ASEAN

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KnowledgeExperience

2013.10.30厚生労働省第3回「国際的なActive Agingにおける日本の貢献に関する検討会」

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How

Study Group for Japan's International Contribution to Active Aging

19Development of “User-oriented ” Cooperation

JapanSide

ASEANSide

Solution (≒ Project )

Problem IdentificationAnalyzing advantages and challenges in ASEAN countries on Elderly care・Health and Welfare services・Poverty and Income Gap・Difference of Urban and Rural area

Portfolio of Japan’s Experience

Identifying appropriate solution for ASEAN countries from the viewpoint of utilizing both their potential strength and Japanese experiences.

Strategy Setting

Identification ofProblems and Solutions

Framework for International Cooperation・Bilateral Approach・Regional/ Global Approach・Industry-academia-government Collaboration・Open Discussion Forum

Cooperation Approach for Government policies Measures for the development of elderly care/ policy・Model projects and System development・Capacity Development・Technical Support for Policy making

Priority Setting

Reorganizing knowledge and experience applicable to Asia・Historical Development・Community based health and welfare activities・Human Resource Development e.g. Caregivers training

Chair: Dr. SHIGERU OMIRegional Director Emeritus, World Health Organization for Western Pacific

2013.6.14厚生労働省第1回「国際的なActive Agingにおける日本の貢献に関する検討会」

ASEAN-Japan SeminarThe Regional Cooperation for the Aging Society

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Date : 9:30am-12:00am On 11th November,2013Venue: ASEAN Hall, the ASEAN SecretariatOpening Remarks :1. H. E. Kimihiro Ishikane, Ambassador of Japan to ASEAN2. Mr. Karry Maramis, Director for Cross-Sectoral Cooperation, ASEAN Socio-Cultural

Community Department, ASEAN Secretariat

Guest Main Speakers :1. Dr. Yutaka HORIE, Deputy Assistant Minister, Ministry of Health, Labour and Welfare of Japan, “Current status of population aging in Asia and a future direction of international cooperation on ‘Active Aging’”2. Dr. Chanvit TARATHEP, Deputy Permanent Secretary, Ministry of Public Health of Thailand , “Aging Society in Thailand”3. Dr. Mu’man NURYANA, Expert Staff on Social Impact Affairs, Ministry of Social Affairs of the Republic of Indonesia, “Inter-generational support flows and its implication to social policy toward active aging in Indonesia”4. Dr. Dwini HANDAYANI, Associate Director, Demographic Institute, University of Indonesia,“The best practice of social welfare policy in ASEAN region, in the context of Indonesia’s situation and future direction”

Outcome :The seminar overviewed the current situation of aging society in Asia, introduced on-going cooperative activities between ASEAN countries and Japan on this issue, and discussed further regional cooperation utilizing portfolio of experience and knowledge in those countries to address aging society and to achieve “Active Aging.”

International Cooperation in the field of the Elderly Persons between Thailand and Japan

Project on the Development of a Community Based Integrated Health

Care and Social Welfare Services Model for Thai Older Persons (CTOP)

(Nov. 2007～ Nov. 2011)

Health and welfare community-based service models were developed at 4 project sites in accordance with the needs of the sites, for example, 1) One-stop service such as

health-check and welfare registration for the elderly people

2) Community rehabilitation3) Prevention activities of high

blood pressureOwnership of the communities was strengthened based on “user-oriented principles”.Guideline of developed services was disseminated nation-wide.

Project on Long-term Care Service Development for the Frail Elderly

and Other Vulnerable People (LTOP)(Jan. 2013～Aug. 2017)

Thai Service models of long-term care will be developed, taking Japanese models into consideration. Service models will be tested both in urban and rural areas and improved.Policy development of the sustainable care system in Thai society will be discussed.Human resource development will support the to-be developed models.

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(ref)

2013.10.30厚生労働省第3回「国際的なActive Agingにおける日本の貢献に関する検討会」

Aging issues in ASEAN countries and Japan’s possible contributions

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Issues in ASEAN countries Japan’s possible contributions

Health

Facility services Secure the quality of services for the middle-income classStandardize facility servicesDevelop facility services to rural areas

A variety of facility services developedPast achievements in standardization (facility standards), “zero” body restraint and elder abuse prevention at three types of long-term care insurance facilitiesRoles of facilities in the integrated community care system

Home services Draw up a strategic roadmap towards development of home servicesDevelop and improve technical skills for each home services

History of service development (e.g. Gold Plan)Development of various home services and staff trainingEstablishment of integrated community care systems

Measures against NCDs

Study and develop specific intervention schemesDevelop action plans and utilize statistic data

Initiatives of annual health-check and intervention for lifestyle improvement

Participation

Social participation

Promote initiatives by utilizing existing social capitalIdentify the fragile elderly who may not be able to participate in the elderly clubs

Local residents’ activities organized at a small sizeBasic checklist to identify the fragile (risky) elderlyLocal initiatives for the integrated community care system

Measures for employment and livelihood

Encourage the elderly to actively participate in activities in order to secure caring resources in local communities

Employment of the elderly through “silver human resource centers”Initiatives by local communities based on the elderly resourcesExtension of retirement age

Security

Health security program

Extend health programs to the informal sectorSecure sustainable financingEstablish basic health services

Establishment and management of the universal health systemA variety of reforms for sustainable health systemFree access and expansion of health services

Income security for the elderly

Improve the coverageImprove the take-up rate and manage expenditures (e.g. old-age welfare allowance)Improve the saving ratio

Universal public pensionUniversal income security program for the elderly (e.g. public assistance, old-age welfare allowance)Variety of financial instruments, saving programs

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Thailand

●Why: Rapid Aging with declining community strength

●Who: Thailand●When: 2007-2017●Where: Community●What: 1 Problem Finding

2 Care Model●How: JICA Project

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• Why• Who• When• Where• What• How

User-Oriented